Context

Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice.

Objective

To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease.

Evidence acquisition

The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion.

Evidence synthesis

Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function.

Conclusions

Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up.

Patient summary

Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture.

中文翻译：

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欧洲泌尿外科协会尿道狭窄疾病指南（第 2 部分）：男性的诊断、围手术期管理和随访

语境

尿道狭窄管理指南是指导循证临床实践的重要工具。

客观的

总结 2021 年欧洲泌尿外科协会 (EAU) 关于男性尿道狭窄疾病诊断、分类、围手术期管理和随访的指南。

取证

专家组对涵盖 2008 年至 2018 年时间范围的主题进行了文献综述，并使用预先定义的文献纳入和排除标准。如果达成专家组共识，则可以包括此时间段以外的关键论文。在小组讨论后，根据对现有文献的回顾，为每项建议添加了强度等级。

证据综合

常规诊断评估包括病史、患者报告的结果测量、检查、尿流测量、尿后残留测量、内窥镜检查和尿道造影。提供三维评估并可能显示相关异常的辅助技术包括超声尿道造影和磁共振尿道造影，尽管这些技术并未常规使用。狭窄的分类应包括狭窄的位置和口径。在提供尿道成形术之前，建议在尿道操作后进行尿道休息。尿道成形术后对尿外渗的评估在导管拔除前是有益的。尿道切开术后导尿的最佳时间为<72 h，但尿道成形术后尚不清楚，取决于多种因素。接受尿道成形术的患者应至少随访 1 年。尿道手术后应评估客观和主观结果，包括患者满意度和性功能。

结论

准确的诊断和分类对于确定管理很重要。充分的围手术期护理和随访对于取得成功的结果至关重要。EAU 指南提供了相关的循证建议，以优化患者的检查和随访。

患者总结

在计划治疗之前，必须对尿道狭窄进行充分评估。手术前，建议进行尿道休息和预防感染。尿道手术后，建议在移除导管之前进行 X 射线染料测试，以确保已经愈合。需要进行常规随访，包括患者报告的结果。这些指南旨在指导医生对尿道狭窄患者进行诊断、护理和随访。